Central retinal artery occlusion following COVID-19 vaccine administration

Abstract

Introduction: Increased risk of thromboembolic events has been associated with SARS-CoV-2 infections and more recently, with COVID-19 vaccination. To date, however, there are no reports of an association between the COVID-19 vaccination and retinal artery occlusions. We report a case of a patient who developed central retinal artery occlusion (CRAO) 2 days following the administration of the AstraZeneca COVID-19 vaccine.

Case description: A 76-year-old woman presented to our Department of Ophthalmology complaining of painless vision loss in her left eye 48 hours after she had received her first dose of the AstraZeneca COVID-19 vaccine. Her best-corrected visual acuity was only hand movement in the left eye. Left eye ophthalmologic examination showed the presence of arterial narrowing and a cherry red spot. Optical coherence tomography showed severe macular swelling of the inner retinal layers in the left eye Fluorescein angiography performed the following day confirmed the diagnosis. The cardiovascular examination including Holter ECG was unremarkable. Complete blood count was within normal limits, without thrombocytopenia. A subsequent cerebral CT and CT-angiography scans did not show any other acute vascular event. Doppler angiography of the carotid artery was performed and showed normal flow without clinically significant plaques, stenoses, occlusions or dissections.

Conclusions: To our knowledge, this is the first case of an isolated CRAO following the administration of the AstraZeneca COVID-19 vaccine. Further studies are needed to evaluate this potential association and identify pathophysiologic relationships between COVID-19 vaccinations and CRAO.

Fig. 1

Clinical and optical coherence tomography findings: (A) Dilated fundus ophthalmoscopy showed the presence of arterial narrowing with cherry red spot (white arrow). (B) Optical coherence tomography showed severe macular swelling of the inner retina layers (red arrows). (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)

Fig. 2

Fluorescein angiography findings: It showed (A) severe delay in the filling of the retinal arteries in the early arterial phase (16 seconds) and (B) central obscuring of the background choroidal fluorescence by retinal swelling in the late phase (5 minutes).